OP17.03: Symptomatic adenomyosis: sonographic findings before and after insertion of levonorgestrel intrauterine system

Recently it has been reported that levonorgestrel intrauterine system could be an effective and safe method in the treatment of adenomyosis. The aim of this study is to assess whether the sonographic detectable morphological alterations of the myometrium induced by adenomyosis changed after the insertion of levonorgestrel intrauterine system (LNG-IUS). Twelve premenopausal symptomatic (menorrhagia, severe dysmenorrhea) patients with sonographic findings typical for adenomyosis were enrolled into the study. All the patients underwent before and at least three months after insertion of the LNG-IUS, a detailed transvaginal sonography which evaluates: uterine diameters and volume, endometrial thickness, presence and dimension of myometrial cystic areas, asymmetric myometrium, presence of myometrial hyperechoich striation, vascularization of the myometrial lesions and accurate mapping of the localisation of the myometrial alterations. A comparison between dimensions and presence of these different signs of adenomyosis before and after insertion of LNG-IUS was performed. Seven patients (58.3%) become amenorrhoic and the other patients referred a significantly reduction in menstrual bleeding. Dysmenorrhea was completely relieved or significantly alleviated in all patients. We observed a significant decrease in uterine volume (716.9 ± 213.8 ml vs. 520.6 ± 148.3 mL). However sonographic signs of adenomyosis such as myometrial cystic areas, asymmetric myometrium, or presence of myometrial hyperechoich striation does not disappear, some decrease in size but not significantly. After insertion of the LNG-IUS in patients with adenomyosis, uterine volume decrease and symptoms relieved or were significantly alleviated. However sonographic sign of adenomyosis seems not to disappear completely. A long term follow-up during and after treatment could be useful to understand the therapeutic role on adenomyosis of LNG-IUS.